Quality improvement: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Badgettrg (talk | contribs)
Bureaucrats, exportpages, nocaptcha, nukepages, oversight, Administrators, Widget editors
3,801 edits
Badgettrg (talk | contribs)
Bureaucrats, exportpages, nocaptcha, nukepages, oversight, Administrators, Widget editors
3,801 edits
Line 19: Line 19:
* "Design behaviour change activities to encourage community adoption of the new behaviours"
* "Design behaviour change activities to encourage community adoption of the new behaviours"
* "Monitor implementation and evaluate the results"
* "Monitor implementation and evaluate the results"
=== Appreciative inquiry ===
Appreciative inquiry is consistent with complexity science<ref name="HuBentler1999">{{cite journal|last1=Hu|first1=Li‐tze|last2=Bentler|first2=Peter M.|title=Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives|journal=Structural Equation Modeling: A Multidisciplinary Journal|volume=6|issue=1|year=1999|pages=1–55|issn=1070-5511|doi=10.1080/10705519909540118}}</ref>.


==Measuring quality==
==Measuring quality==

Revision as of 18:36, 16 October 2020

For other uses, see QI (disambiguation).

Quality improvement is "the attainment or process of attaining a new level of performance or quality."[1].

Wennberg's classification framework can categorize causes of unwarranted variation[2].

Methods

Lean Sigma

Lean sigma combines approaches[3].

Positive deviance

Main article: Positive-deviance

A positive deviance approach has been recommended to identify and disseminate best organizational practices[4][5] [6]Early description of this method was[4]:

  • "Develop case definitions"
  • "Identify four to six people who have achieved an unexpected good outcome despite high risk"
  • "Interview and observe these people to discover uncommon behaviours or enabling factors that could explain the good outcome"
  • "Analyse the findings to confirm that the behaviours are uncommon and accessible to those who need to adopt them"
  • "Design behaviour change activities to encourage community adoption of the new behaviours"
  • "Monitor implementation and evaluate the results"

Appreciative inquiry

Appreciative inquiry is consistent with complexity science[7].

Measuring quality

Quality measures and their benchmarks are available form several organizations including:

  • CQI Resource Center (coordinated by the Centers for Medicare & Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC); U.S. Department of Health and Human Services)

Goodhart's law is when measures become organizational goals, problems may ensue.

Tactics for improvement

A conceptual model has been developed[8] and recommended by the AHRQ[9].

Practice facilitation

Practice facilitation may help based on the experience of the American Academy of Family Physicians' (AAFP) National Demonstration Project (NDP)[10][11].

The Heart Health NOW Study found uncertain evidence from organizational leadership and Adaptive Reserve[12].

The VA's PACT used in-person[13] and online[14] collaborative methods.

The NHS...

Workforce redesign

Workforce redesign may help[15].

Why quality improvement efforts succeed and fail

Various organizational characteristics, some based on complexity science[16][17], may predict why quality improvement projects succeed[18][19][20] and fail[21][22][23]. Causes include:

Studies using appreciative inquiry have been done.[21][27]

Different approaches may be needed depending on the level of certainty in the clinical science behind a quality improvement project.[28]

Recommendations for QI projects to implement guidelines may not include tactics to foster a positive workplace culture[29][29].

Work culture and quality improvement

A systematic review found an association with workplace culture and clinical outcomes[30]. However, this review did not provide details of attributes of positive culture. This review did not find any randomized trials.

A cross-sectional study of 537 American hospitals found that clinical improvement was associated with the following, ranked in descending order of impact[31]:

  • 'having physician and nurse champions rather than nurse champions alone'
  • 'fostering an organizational environment in which clinicians are encouraged to solve problems creatively'
  • 'holding monthly meetings to review AMI cases between hospital clinicians and staff who transported patients to the hospital'

A cohort of 10 American hospitals found[32]:

  • 'effective inclusion of staff from different disciplines and levels in the organisational hierarchy in the team guiding improvement efforts (referred to as the ‘guiding coalition’ in each hospital)'
  • 'authentic participation in the work of the guiding coalition'
  • 'distinct patterns of managing conflict'

The Malcolm Baldrige Health Care version of the Criteria for Performance Excellence (HCPE) award has been created to foster a culture of quality improvement across an organization. Two studies of the impact of the award have found:

  • "No significant difference in process of care results or outcomes between Baldrige recipients and their competitors, there was a significant difference in patient experience results" [33].
  • "Slight enhancements in clinical outcomes, while hospital financial and efficiency measures all showed overwhelmingly positive operating results"[34]

References

  1. ↑ Anonymous (2025), Quality improvement (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Harrison R, Manias E, Mears S, Heslop D, Hinchcliff R, Hay L (2018). "Addressing unwarranted clinical variation: A rapid review of current evidence". J Eval Clin Pract. doi:10.1111/jep.12930. PMID 29766616.
  3. ↑ Danese, P., Manfè, V. and Romano, P. (2017), A Systematic Literature Review on Recent Lean Research: State-of-the-art and Future Directions. International Journal of Management Reviews. doi:10.1111/ijmr.12156
  4. ↑ 4.0 4.1 Marsh DR, Schroeder DG, Dearden KA, Sternin J, Sternin M (2004). "The power of positive deviance". BMJ. 329 (7475): 1177–9. doi:10.1136/bmj.329.7475.1177. PMC 527707. PMID 15539680.
  5. ↑ Bock, L. (2015). The Two Tails. In: Work rules!: Insights from inside Google that will transform how you live and lead. Twelve. ISBN 1455554790
  6. ↑ Baxter R, Taylor N, Kellar I, Lawton R (2016). "What methods are used to apply positive deviance within healthcare organisations? A systematic review". BMJ Qual Saf. 25 (3): 190–201. doi:10.1136/bmjqs-2015-004386. PMC 4789698. PMID 26590198.
  7. ↑ Hu, Li‐tze; Bentler, Peter M. (1999). "Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives". Structural Equation Modeling: A Multidisciplinary Journal. 6 (1): 1–55. doi:10.1080/10705519909540118. ISSN 1070-5511.
  8. ↑ Garman AN, McAlearney AS, Harrison MI, Song PH, McHugh M (2011). "High-performance work systems in health care management, part 1: development of an evidence-informed model". Health Care Manage Rev. 36 (3): 201–13. doi:10.1097/HMR.0b013e318201d1bf. PMID 21646880.
  9. ↑ Appendix 1. Definitions of High-Performance Work Practices. Content last reviewed August 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/clabsi-hpwpreport/clabsi-hpwpap.html
  10. ↑ Wang A, Pollack T, Kadziel LA, Ross SM, McHugh M, Jordan N; et al. (2018). "Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review". J Gen Intern Med. doi:10.1007/s11606-018-4581-9. PMID 30066117.
  11. ↑ Chase SM, Crabtree BF, Stewart EE, Nutting PA, Miller WL, Stange KC; et al. (2015). "Coaching strategies for enhancing practice transformation". Fam Pract. 32 (1): 75–81. doi:10.1093/fampra/cmu062. PMID DOI: 10.1093/fampra/cmu062[Indexed for ME 25281823 DOI: 10.1093/fampra/cmu062[Indexed for ME Check |pmid= value (help).
  12. ↑ Henderson KH, DeWalt DA, Halladay J, Weiner BJ, Kim JI, Fine J; et al. (2018). "Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study". Ann Fam Med. 16 (Suppl 1): S29–S34. doi:10.1370/afm.2210. PMC 5891311. PMID 29632223.
  13. ↑ Bidassie B, Davies ML, Stark R, Boushon B (2014). "VA experience in implementing Patient-Centered Medical Home using a breakthrough series collaborative". J Gen Intern Med. 29 Suppl 2: S563–71. doi:10.1007/s11606-014-2773-5. PMC 4070243. PMID 24715402.
  14. ↑ Luck J, Bowman C, York L, Midboe A, Taylor T, Gale R; et al. (2014). "Multimethod evaluation of the VA's peer-to-peer Toolkit for patient-centered medical home implementation". J Gen Intern Med. 29 Suppl 2: S572–8. doi:10.1007/s11606-013-2738-0. PMC 4070245. PMID 24715401.
  15. ↑ Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJ (2018). "Nurses as substitutes for doctors in primary care". Cochrane Database Syst Rev. 7: CD001271. doi:10.1002/14651858.CD001271.pub3. PMID 30011347.
  16. ↑ Massoud MR, Barry D, Murphy A, Albrecht Y, Sax S, Parchman M (2016). "How do we learn about improving health care: a call for a new epistemological paradigm". Int J Qual Health Care. 28 (3): 420–4. doi:10.1093/intqhc/mzw039. PMC 4931911. PMID 27118664.
  17. ↑ Jordon M, Lanham HJ, Anderson RA, McDaniel RR (2010). "Implications of complex adaptive systems theory for interpreting research about health care organizations". J Eval Clin Pract. 16 (1): 228–31. doi:10.1111/j.1365-2753.2009.01359.x. PMC 3667707. PMID 20367840.
  18. ↑ Leykum LK, Pugh J, Lawrence V, Parchman M, Noël PH, Cornell J; et al. (2007). "Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes". Implement Sci. 2: 28. doi:10.1186/1748-5908-2-28. PMC 2018702. PMID 17725834.
  19. ↑ Leykum LK, Parchman M, Pugh J, Lawrence V, Noël PH, McDaniel RR (2010). "The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure". Implement Sci. 5: 66. doi:10.1186/1748-5908-5-66. PMC 2936445. PMID 20735859.
  20. ↑ Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT (2013). "How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts". Soc Sci Med. 93: 194–202. doi:10.1016/j.socscimed.2012.05.040. PMID 22819737.
  21. ↑ 21.0 21.1 Ruhe MC, Bobiak SN, Litaker D, Carter CA, Wu L, Schroeder C; et al. (2011). "Appreciative Inquiry for quality improvement in primary care practices". Qual Manag Health Care. 20 (1): 37–48. doi:10.1097/QMH.0b013e31820311be. PMC 4222905. PMID 21192206.
  22. ↑ Arar NH, Noel PH, Leykum L, Zeber JE, Romero R, Parchman ML (2011). "Implementing quality improvement in small, autonomous primary care practices: implications for the patient-centred medical home". Qual Prim Care. 19 (5): 289–300. PMC 3313551. PMID 22186171.
  23. ↑ Michel, P., et al. "What are the Barriers and Facilitators to the Implementation and/or Success of Quality Improvement and Risk Management in Hospitals: A Systematic Literature Review." J Epidemiol Public Health Rev 1.4 (2016).
  24. ↑ Rose AJ, Petrakis BA, Callahan P, Mambourg S, Patel D, Hylek EM; et al. (2012). "Organizational characteristics of high- and low-performing anticoagulation clinics in the Veterans Health Administration". Health Serv Res. 47 (4): 1541–60. doi:10.1111/j.1475-6773.2011.01377.x. PMC 3401398. PMID 22299722.
  25. ↑ 25.0 25.1 Curry LA, Spatz E, Cherlin E, Thompson JW, Berg D, Ting HH; et al. (2011). "What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study". Ann Intern Med. 154 (6): 384–90. doi:10.7326/0003-4819-154-6-201103150-00003. PMC 4735872. PMID 21403074.
  26. ↑ 26.0 26.1 Gabbay RA, Friedberg MW, Miller-Day M, Cronholm PF, Adelman A, Schneider EC (2013). "A positive deviance approach to understanding key features to improving diabetes care in the medical home". Ann Fam Med. 11 Suppl 1: S99–107. doi:10.1370/afm.1473. PMC 3707253. PMID 23690393.
  27. ↑ Peelle, Henry E. (2006). "Appreciative Inquiry and Creative Problem Solving in Cross-Functional Teams". The Journal of Applied Behavioral Science. SAGE Publications. 42 (4): 447–467. doi:10.1177/0021886306292479. ISSN 0021-8863.
  28. ↑ Leykum LK, Lanham HJ, Pugh JA, Parchman M, Anderson RA, Crabtree BF; et al. (2014). "Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science". Implement Sci. 9: 165. doi:10.1186/s13012-014-0165-1. PMC 4239371. PMID 25407138.
  29. ↑ 29.0 29.1 Harrison MB, Légaré F, Graham ID, Fervers B (2010). "Adapting clinical practice guidelines to local context and assessing barriers to their use". CMAJ. 182 (2): E78–84. doi:10.1503/cmaj.081232. PMC 2817341. PMID 19969563.
  30. ↑ Braithwaite J, Herkes J, Ludlow K, Testa L, Lamprell G (2017). "Association between organisational and workplace cultures, and patient outcomes: systematic review". BMJ Open. 7 (11): e017708. doi:10.1136/bmjopen-2017-017708. PMC 5695304. PMID 29122796.
  31. ↑ Bradley EH, Curry LA, Spatz ES, Herrin J, Cherlin EJ, Curtis JP; et al. (2012). "Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction". Ann Intern Med. 156 (9): 618–26. doi:10.7326/0003-4819-156-9-201205010-00003. PMC 3386642. PMID 22547471.
  32. ↑ Bradley EH, Brewster AL, McNatt Z, Linnander EL, Cherlin E, Fosburgh H; et al. (2018). "How guiding coalitions promote positive culture change in hospitals: a longitudinal mixed methods interventional study". BMJ Qual Saf. 27 (3): 218–225. doi:10.1136/bmjqs-2017-006574. PMC 5867433. PMID 29101290.
  33. ↑ Schulingkamp, R. C., & Latham, J. R. (2015). Health Care Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors.
  34. ↑ Unger, K. L. (2013). An investigation into the effects of winning the Malcolm Baldrige National Quality Award on the performance of hospitals/healthcare systems (Doctoral dissertation, Colorado State University).


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Quality_improvement&oldid=1669849"